06-017 (13) ENDORSEMENT' OF APPROVAL NOT REQUIRED (ANR) PLAN 09!W_,^File with the Office of Planning and Development �"�
City of Northampton,Massachusetts
L Deed recorded in Hampshire County Registry of Deeds or Land Court: Boo Page i 3-
2. Street Address: .137
3. Assessor's Map: G Lot(s):�l4(gAdditional property description:
4. Number of newly created lots: f
5. Checklist of$ling requirements (check the supplied items. Applications MUST have these items.)
❑ Original, reproducible(mylar) Plan, with endorsed Seal of a Massachusetts Registered
Professional Land Surveyor.
❑ Six(6)prints of the Plan. y"
❑ Original and Six(6) copies of the fully completed and endorsed ANR Application form. ' S
❑ $150 per sheet fee plus $50 for each newt created lot
P P y (payable to"City of Northampton").
❑ If any portion of a plan falls within 500 feet of a published control point(see :
NorthamptonPlanning.org): four centimeter-accuracy points on each sheet tied into the
Massachusetts State Plane Coordinate System(NAD 1983 datum), using said published con trol 1
points or the global positioning system and noting the coordinates of the tie-in points, the dattun, '.
and the source and location of monuments used for data. -
❑ An electronic version of the plan in model '
p space in DWG, DXF, or Shape format including:
o All property lines,buildings and geographic features shown on the plans.
o Closure of all property boundaries of one part in 20,000
❑ Plans show all buildings owned by subject landowner(s)within 100'of any newly created
property lines.
C Plans include a statement that the Planning Board's endorsement is not a determination that the
lots shown are buildable lots.
We believe and understand that:
(1) The attached plan is not a division as defined in the Subdivision Control Law and we submit
it for endorsement that Planning Board approval under this Law is not required; and
(2) we have provided all the information required in the checklist above; and
(3) The plans submitted are now in the public domain and may be co pi d freely in any for-n.
Applicant (print or type):;�/ A _%?,� Signature: (w°
Address: ._9.3 .7 �8.�� ,y y�yLG.e?- /�! Phone: y%3 7
Owner(print or type): Wj=,,4 .4,41 42YY ku Signature:
Address: S''A/Yl;�77 Phone: �
Surveyor (print or type)://Gik I-X4,da,—Signature:
Address:���s 5� LA. Phone:
Allow 21 days for processing. It is the applicant's responsibility to pickup the original drawing and
record it at the Registry of'Deeds or Land Court within the time limits established by the Registry. All
copies and forms remain with the City. Applicants may file one copy of this•ANR form with the City Clerk
to protect theirjapfeal rights.
Date Sub _� G Date Decision Fil : , J o
• e
City Cl City Clerk(signs ,(�� —�
IANM Appti an, orm R:lns _:2002) —�
L